You’ve commented on how some of the major mindfulness teachers downplay compassion or the lack of focus on compassion. Can you expand on this a little bit and explain why compassion is such an integral part of mindfulness? Is mindfulness useless without compassion?

At present, a great deal of research suggests that from the moment we are born until the day that we die our experience of kindness, support, and compassion will greatly influence our emotional and physical health. The potential extent of the influence of the presence or absence of compassion reaches from how healthy our immune system may function, to the intensity of our stress response, to the presence or absence of anxiety and depression. In some research, self-compassion appears to be a major mediator of how successful people might be in mindfulness based group or self-help text based treatments.

Given this research, we would expect that mindfulness-based therapies would be moving towards employing compassionate mind training as a part of their approach. However, this isn’t always the case. Some mindfulness teachers believe that compassion is so inherent to mindfulness training that we don’t need to focus on it. We never viewed the situation that way. To our minds, that would be akin to saying, “There is enough cardiovascular training that shows up in weight training, so most athletes don’t need to do cardio on its own.”

Mindfulness is often defined as the kind of awareness that emerges by paying attention in the present moment, on purpose and non-judgmentally—a definition or translation of the Pali term Sati attributable to Jon Kabat-Zinn. Compassion can be defined as a sensitivity to the presence of suffering in self and others, combined with a deep motivation and commitment to the alleviation and prevention of suffering. This definition has its roots in Buddhist writings, but has been articulated and refined by Paul Gilbert, the founder of compassion-focused therapy (CFT). Clearly, these definitions stand for different concepts. And while there is some overlap in the behavioral and neural dynamics involved in mindfulness and compassion, different practices, motivations, and regions of neural activity are differentially engaged in both mindfulness and compassion activation.

Some people have described mindfulness and compassion as two wings of a bird, with both playing their role in allowing our human aspirations for transformation and personal evolution to take flight. While a poetic metaphor, we appreciate the meaning of the image, as the flow between activating our flexible, focused awareness and acting from the compassionate mind can be so essential in psychotherapy and everyday life.

Within prescientific Buddhist traditions, mindfulness training is often a beginning point for the novice monk or lay practitioner. From this foundation, the Buddhist student will proceed to learn and practice more advanced methods for cultivating a felt sense of compassion for the self, and ultimately for all beings. This is true in many schools of Buddhist practice, including Theravada, Zen, and Tibetan Buddhism.

The sequencing of this mental training would suggest that there is a relationship between the experience of mindfulness and the experience of compassion, where mindfulness training may serve as a context for the cultivation of compassion. The Buddhist scholar B. Alan Wallace has emphasized that historically, mindfulness training has been undertaken as a foundational practice that allows the practitioner to be ready to access and embody wholesome states of mind that lead to ethical and healthy behaviors.

Mindfulness involves the nonjudgmental and decentered appreciation and acceptance of our experience, just as it is, in this very moment. However, this acceptance is not meant to serve as an end in itself, or a form of masochistic immersion in distress. From the perspective of an ACT practitioner, acceptance is an active process in the cultivation of psychological flexibility and movement towards a life of meaning, purpose, and vitality. For the Buddhist practitioner, mindful acceptance sets the stage for the cultivation of wisdom, compassion, and right action. Mindfulness alone has rarely been the aim of practical philosophies and interventions throughout history. It may be that without self-compassion, we might sometimes be forcing ourselves into contact with our pain without the supportive and protective presence of our evolved capacity for sensitivity to suffering or motivation to respond with kindness and support. Our friends Kristin Neff and Chris Germer have made the distinction that while mindfulness may be the open acceptance of our experience, compassion involves a wholehearted acceptance of the experiencer herself. To our minds and hearts, compassion feels like a psychological, and perhaps spiritual, coming home—finding a safe base from which to explore our world and face the inevitable challenges of life.

Can you talk a bit about how and why you decided to do a book on ACT and compassion, why you felt there was a need for it—what in your professional or personal experience led to its creation?

[DT] I came to study Western psychology and behavior therapy after decades of Buddhist practice, and my intention since 1992 really has been to integrate Buddhist psychology with our best methods for alleviating suffering based on a scientific paradigm. [LS] I also had a long-standing passion for Buddhist psychology, and particularly the role of mind-body medicine which seemed more overt in Eastern practices like yoga and tai chi.

When we began working together 10 years ago, we both had studied cognitive therapy, acceptance and commitment therapy, and a variety of meditation disciplines. As we both became more immersed in the practice of CFT and ACT, it became clear on a personal level that the integration of the evidence-based processes found in ACT and the brilliant model derived from affective neuroscience and developmental psychology that is found in CFT could work together to great effect.

[LS] In particular, there was a weekend workshop that Dr. Tirch was addressing at the Samye Ling Tibetan Buddhist monastery, during one of the biggest snowstorms in Scotland in 70 years, that led to this book. After speaking on compassion and meditating together, we both came to see the clear relationship between psychological flexibility and the many aspects of compassion that are trained in CFT.

About 7 years ago we began working very closely with Dr. Paul Gilbert, with one of us [DT] spending a great deal of time developing a model for how to use CFT to treat anxiety disorders.

At the same time, we increasingly discussed compassion and psychological flexibility with Kelly Wilson, Robyn Walser, Steven Hayes and others in the ACBS community. It began to make sense to systematize and codify our work integrating these approaches. Our dear friend and co-author, Benjamin Schoendorff, felt like a natural partner in this work, as we had worked with him in workshops on contextual behavioral science and self-compassion.

As cognitive and behavioral therapies have increased their emphasis on applied mindfulness- and acceptance-based approaches, it makes sense that mental training designed to intentionally foster a compassionate mind would become a growing trend in contextual behavior therapies like ACT and FAP. Contextual behavior therapies inherently address the interconnectedness between an organism and its context in a way that resonates with Buddhist psychology and the science of compassion. Additionally, this emphasis on compassion within behavioral therapies is a part of a trend toward greater integration of compassion-focused methods and Buddhist influences within psychotherapy across many theoretical approaches.

The ACT model can be tricky even for advanced practitioners. Compassion is not a formal part of the hexaflex, so how and where does it fit in? What are some of the best entry points or inherently compassionate processes in the ACT model that could help practitioners begin to infuse their practice with more compassion?

In approaching this question we can begin by considering what we are looking at when we view the hexaflex. Basically, the hexaflex is meant to be a graphic illustration of the interacting, active processes that contribute to psychological flexibility. Steven Hayes has publicly stated that compassion might be the only value that is inherent in the hexaflex model. I think we can take that a bit further, actually, because compassion doesn't need to be viewed simply as a value.

Compassion is a multifaceted process that has evolved from the caregiver mentality found in human parental care and childrearing. As such compassion involves a number of emotional, cognitive, and motivational elements.

The emerging common ground across psychological science is that compassion is an evolved motivational experience that organizes the mind into a complex and multimodal series of human behaviors with clear antecedents in the repertoire-broadening influence of secure attachment experiences. Importantly, compassion involves the activation of the emotions that arise in connected, intimate, and close relationships. We refer to these emotions—which involve empathy, warmth, and care—as affiliative emotions. Activation of networks of affiliative emotions can promote focused, flexible attention and a broadening of the range of possible actions in the presence of stimuli that typically narrow behavioral repertoires. Indeed, research has increasingly established that compassion can facilitate lasting change in the way we experience and respond to suffering.

On the basis of the significant overlap between the attributes and skills that emerge from a compassionate mind and the components of psychological flexibility, we have offered a definition of “compassionate flexibility” in our work that relates the hexaflex to compassion. So rather than compassion sitting in any one place “on” the hexaflex, compassionate flexibility reflects a particular quality of engaged psychological flexibility.

We define compassionate flexibility as the ability to contact the present moment fully, as a conscious and emotionally responsive human being with the following qualities:

Sensitivity to the presence of suffering in oneself and others
Motivation to alleviate and prevent human suffering in oneself and others

Persistent adaptation to competing and changing environmental, emotional, and motivational demands, and commitment to returning attention and resources to the alleviation and prevention of suffering in oneself and others

The ability to flexibly shift perspective and access a broader sense of oneself and others, involving the experiences of empathy and sympathy

The ability to disentangle oneself from the excessive influence of evaluative, judgmental thoughts

Maintaining an open and noncondemning perspective on human experience itself, thereby cultivating necessary and sufficient willingness to tolerate the distress encountered in oneself and others

New Harbinger has published proven-effective self-help books and workbooks, as well as professional books on topics in psychology, health, and personal growth. Our books provide evidence-based therapies such as acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), cognitive behavioral therapy (CBT), mindfulness, and more.